Sunday, May 31, 2015

Jeb Bush's Addiction

"Grim choice for N.Y. addicts: relapse or be homeless" by Kim Barker New York Times May 31, 2015

NEW YORK — After a lifetime of abusing drugs, Horace Bush decided at age 62 that getting clean had become a matter of life or death.

So Bush, a homeless man who still tucked in his T-shirts and ironed his jeans, moved to a flophouse in Brooklyn that was supposed to help people like him, cramming into a bedroom the size of a parking space with three other men.

Bush signed up for a drug-treatment program and emerged nine months later determined to stay sober. But the man who ran the house, Yury Baumblit, a longtime hustler and two-time felon, had other ideas.

Baumblit got kickbacks on the Medicaid fees paid to the outpatient treatment programs that he forced all his tenants to attend, residents and former employees said. So he gave Bush a choice: If he wanted to stay, he would have to relapse and enroll in another program. Otherwise, his bed would be given away.

“ ‘Do what you do’ — that’s what he told me,” Bush recalled.

Bush, rail-thin with sad eyes, wanted to avoid the streets and homeless shelters at all costs. He turned to his self-medication of choice: beer, with a chaser of heroin and crack cocaine. Then he enrolled in a new program chosen by Baumblit.

In the past 2½ years, Bush has gone through four programs, just to hold onto his upper bunk bed.

Bush had fallen into a housing netherworld in New York City, joining thousands of other single men and women recovering from addiction or with nowhere to go. The homes are known as “three-quarter” houses, because they are seen as somewhere between regulated halfway houses and actual homes.

Virtually unnoticed and effectively unregulated, the homes have multiplied in the past decade, driven by a push to reduce shelter rolls, a lack of affordable housing, and unscrupulous operators.

One government official estimated recently there could be 600 three-quarter houses in Brooklyn alone. But precise numbers are elusive. The houses open and close all the time, dotting poor neighborhoods mostly in the Bronx, Brooklyn, and Queens.

The homes, often decrepit and infested with vermin, overflow with bunk beds and people. Exits are blocked and fire escapes nonexistent. The homes are considered illegal because they violate building codes on overcrowding. Many have become drug dens, where people seem almost as likely to die of overdoses as they are to move on to a home of their own.Related: The homeless shelter population has surged under Bloomberg’s tenureAll been forgotten now that de Blasio is in office.

Opportunistic businessmen such as Baumblit have rushed to open new homes, turning them into vehicles for fleecing the government, an investigation by The New York Times found. The target is easy: vulnerable residents whose rents and treatments are paid with taxpayer money.

Yet three-quarter homes are tolerated and even tacitly encouraged, pointing to a systemic failure by government agencies and institutions responsible for helping addicts and the poor.Honestly, it is not $urpri$ing at all.

Reputable hospitals, treatment programs, and shelters regularly send people to the homes. So does the state’s Department of Corrections and Community Supervision.

The city’s Human Resources Administration pays operators the $215 monthly rent, known as a “shelter allowance,” for many tenants. The state’s Office of Alcoholism and Substance Abuse Services hands out millions in Medicaid money for their treatment.

But for years none has paid attention to what happens inside. There are no regular inspections. No requirements. No registry. The city’s Department of Buildings, overwhelmed and ineffectual, often fines the landlords, but the city does little to collect.

The system, such as it is, dooms tenants to a perpetual cycle of treatment and relapse, of shuttling between programs and three-quarter houses.And who benefits?

Fire chiefs from across the region made an urgent, at times personal, appeal to the nation’s drug czar Monday to support their fight against the opioid epidemic, calling for greater funding for addiction treatment and supplying firefighters with Narcan, a drug that reverses heroin overdoses.

In a morning round-table meeting, the chiefs told Michael Botticelli, director of the Office of National Drug Control Policy, that the scope of the crisis demanded immediate action. Some described firsthand accounts of reviving overdose victims with Narcan, and growing efforts to steer addicts toward treatment.Part of Obummer's new team who says there is no silver bullet to the kids.

“It’s an epidemic that has no boundaries,” said Keith Stark, fire chief in Weymouth, at Boston Fire Department headquarters. Ten people have died from opioid overdoses this year in Weymouth, and firefighters there have saved well over 100 people from overdoses since they began carrying Narcan two years ago, part of a growing number of departments that now use the powerful drug.

With the help of community groups, firefighters in some towns are providing information about treatment to those battling addiction in hopes of persuading them to seek counseling.

More than 1,000 people in Massachusetts died from overdoses of heroin and other opioids last year, a 33 percent increase from 2012. Nationally, fatal overdoses, especially from nonmedical use of prescription drugs, has surged over the past decade, and has surpassed motor vehicle crashes as the leading cause of injury deaths.

Botticelli said the epidemic required action on several fronts, from expanded treatment options to reducing the vast supply of pain medication, both on the street and in people’s homes. “It requires a comprehensive approach,” he said.

US Senator Ed Markey said approximately 120 Americans die from drug overdoses every day, and called for increased funding for drug treatment programs.The CIA black profits and laundered bottom lines of banks make it all worth it.

Markey said the epidemic was “out of control,” and said the medical use of painkillers was too widespread. About four out of five new heroin users had previously abused prescription painkillers, studies have shown.

“We need to stop the overprescribing of pain medication,” he said.They are a.... gateway drug?

US Representative Stephen Lynch noted that firefighters are increasingly on the front lines of the epidemic, and that their medical efforts needed to be tied into a broader response to drug addiction that involved hospitals, health clinics, and treatment facilities.

“We’re all grappling with this problem,” he said.

US Representative Katherine Clark said she supported outreach efforts for people battling opioid abuse to connect them to help “before it’s too late.”

“It is cutting across our communities,” she said. “We’re losing a generation of young people.”Looks like a lost war to me. 120 deaths a day?

Clark recently filed legislation to help hospitals treat newborns suffering from opiate exposure. From 2000 to 2012, the number of infants suffering from withdrawal grew nearly fivefold, a new study has found.

In Revere, firefighters have launched a new outreach program aimed at reducing overdoses by returning to the homes of overdose victims to speak with them about treatment options. The department is collaborating with Kim Hanton, director of addiction services at North Suffolk Mental Health Association.

“Some people aren’t ready for treatment,” Hanton said. “You’re really there to engage.”

The families of those struggling with substance abuse are often looking for help and guidance, she said.

Between early February and April, Revere firefighters used Narcan 136 times to reverse overdoses, a dramatic increase.

In Boston, firefighters have used the drug more than 300 times in less than a year, officials said. A dose costs about $40.

The department will monitor the outreach program in Revere to see if Boston could launch a similar effort, a spokesman said.

Gene Doherty, the fire chief in Revere, said firefighters are increasingly taking on medical and public health responsibilities, particularly as opioid overdoses have become more common. “Fire service evolves,” he said. “We are the people on the front lines.”

Doherty said some children begin dabbling in prescription drugs in middle school before moving on to heroin.

"A Chicopee man who police said used McDonald’s Happy Meal toy bags to conceal heroin deliveries has been indicted by a Hampden County grand jury. Narcotics detectives arrested Giovannie Luna on April 15 after he allegedly attempted to make a drug sale in Springfield. Police seized more than 9,500 packets of heroin in the arrest in addition to cash and a loaded .22-caliber handgun recently reported stolen in Westfield, police officials said. The Springfield Republican reported that Luna, 31, was initially due in Springfield District Court before he was indicted and had his case transferred to Superior Court. He is expected to be arraigned in Superior Court next week."That's going to make someone sad.

He faces 11 counts of illegal prescribing, nine counts of making false claims to Medicaid, and one count of larceny over $250. He has surrendered his medical license and will be arraigned at a later date, prosecutors said in a statement.

“Physicians have a responsibility to care for their patients and keep them safe and healthy. Our investigation revealed that Dr. Nassery violated that trust by writing prescriptions he knew were medically unnecessary and providing powerful painkillers to people with documented substance abuse problems,” Attorney General Maura Healey said.

Prosecutors said that medical records indicated Nassery prescribed oxycodone and oxycodone-based medications to patients with documented substance abuse problems and after learning some patients were enrolled in treatment programs or were getting opioids from other providers.

The prescriptions he wrote allegedly caused pharmacies to falsely bill MassHealth for the drugs, prosecutors said.

Healey’s office said that the charges were part of her push to “tackle the opioid and heroin epidemic from all angles.”

State officials say the opioid crisis has swept through cities and towns across Massachusetts, accounting for more than 1,000 deaths last year, the Globe reported Sunday. The town of Plymouth has been especially hard-hit, with 10 drug-related deaths this year as of Saturday....

"A sheriff’s officer who lost his son to heroin teamed with an inmate to save another man from the same fate. The Essex County sheriff’s office said corrections Sergeant Dennis Laubner was supervising five inmates doing litter pickup Monday in Lawrence when a young woman pulled behind their van. She said her boyfriend was unconscious in her car after overdosing. Officials said Laubner and inmate Dennis Dicato gave the man CPR, and he had revived by the time an ambulance crew came to administer a heroin antidote. The Eagle-Tribune reported that Laubner told the woman about his son and urged her to get her friend addiction help."

"Two Holyoke men have been arrested on drug charges after an investigation into heroin distribution in that city, State Police said. The Hampden County Narcotics Task Force has been investigating heroin distribution in Holyoke for several months. Over the course of the investigation, more than 3,700 bags of heroin were seized, State Police said. Julio Rosado, 20, and Armando Vega, 27, were arrested Tuesday, State Police said. Rosado faces two counts of trafficking of a Class A drug. Vega is charged with trafficking a Class A drug and possession with intent to distribute a Class B drug, oxycodone.""The state’s highest court on Tuesday overturned the indictment of a teenage boy on a heroin trafficking charge, ruling it was not a violent act under the youthful offender law. The law allows juveniles to be tried as adults in Massachusetts if the charges against them involve ‘‘infliction or threat of serious bodily harm.’’ The Supreme Judicial Court concluded that the heroin charge did not meet that standard and ordered the indictment dismissed. The defendant, who was not identified because of his age, was 16 when he was arrested in 2013 by Taunton police. The boy was later indicted on a charge of possession of heroin with intent to distribute, moving the case to adult court, where the penalties can be harsher than in the juvenile system (AP)."

"Everett police are warning of a new synthetic drug being marketed to teenagers, after officers arrested two people who are believed to have consumed it over the weekend, officials said. The new drug, called NBOMe, is a hallucinogen that even in extremely small amounts can cause “seizures, cardiac and respiratory arrest, and death,” the US Drug Enforcement Administration said in late 2013. In the two incidents in Everett, police said the alleged users displayed strange, self-destructive behavior. NBOMe, sometimes called “N-bomb” or “Smiles,” is sold in many forms: powder, liquid solution, laced on edible items, and soaked onto paper, the DEA said." CIA dumping more bad acid into the populace like they did in the '60s?

Cristina Barbuto was thrilled when she landed her new marketing job last year.

Her delight quickly evaporated when she was fired after her first day because a drug test revealed marijuana use. She lost her job even though she’d disclosed during her interview that she takes the drug, with a doctor’s legal permission, to ease the symptoms of a digestive disorder.

Now, the 34-year-old Brewster woman is fighting for her right to use medical marijuana at home and not be fired for it. Her lawyers on Friday filed a complaint with the Massachusetts Commission Against Discrimination over her termination — a case that is believed to be the first of its kind in the state involving marijuana and employment, an agency spokesman said.

“This is something that needs to change,” Barbuto said. “I don’t want people to fear looking for these types of jobs and be humiliated because of this.”

With marijuana now legal for medical use in Massachusetts and 22 other states and the District of Columbia, the question of how workplaces deal with such use — especially drug screening tests for employment — has become a thorny, and far from settled, issue.

Because marijuana is still prohibited under federal law, states are left to craft their own rules, and employers have been caught in a legal morass.

Two Massachusetts law firms have joined forces to advocate for Barbuto’s case — one that specializes in employment law, the other in emerging marijuana issues.

“We have gotten a spike in these types of calls,” said Adam Fine, whose Boston firm, Vicente Sederberg, is known for helping businesses win licenses to open marijuana dispensaries.

Fine’s office recently received a call similar to Barbuto’s from a worker fired from a Massachusetts casino company after a drug screening test.

Matthew Fogelman, whose Newton law firm handles discrimination lawsuits, said the state’s 2012 medical marijuana law prohibits employers from firing workers such as Barbuto who have legally obtained a doctor’s certification to use marijuana for health reasons.

“As long as it is not affecting that person’s ability to perform their job, then it should be protected, and that person should not suffer adverse consequences,” said Fogelman, who teamed with Fine on Barbuto’s case.

Barbuto said she was diagnosed with Crohn’s disease in 2011, an illness that often robs a patient’s appetite. Because she rarely feels hungry, Barbuto struggles to maintain a healthy weight, and traditional medicines have not helped, she said. So she smokes a small amount of marijuana before meals a couple of times a week, she said, to spur her appetite, but not enough to make her feel high.

Even though marijuana dispensaries have yet to open in Massachusetts, state law allows patients with certification from a doctor to use the drug. Barbuto said she received her certification last summer.

Barbuto’s marijuana use had not been a workplace issue before, because she had been working freelance. She loved working in marketing, but thought her old job lacked opportunities to advance. So when a recruiter told her about a position at Advantage Sales and Marketing in September 2014, Barbuto applied. Barbuto told the man who became her boss that she would test positive for marijuana on the company’s drug test because of her medical use, according to the complaint.

She was told that would not be an issue, the complaint states, and was hired. The first day went well and Barbuto was excited about the future as she described her day to her boyfriend that night.

Then the phone rang.

It was Joanne Meredith Villaruz, the company’s human resources representative, calling to say Barbuto was being fired for testing positive for marijuana, according to the complaint. When Barbuto questioned the termination, noting the state’s medical marijuana law and her doctor’s certificate, Villaruz told her, “We follow federal law, not state law,” the complaint said.

Villaruz, who has since left the company, declined to comment in an e-mail Friday and referred questions to Advantage Sales and Marketing’s headquarters in California. Barbuto’s complaint names both Villaruz and Advantage.

Tania King, Advantage’s chief legal officer, did not return calls and an e-mail.

Most states’ medical marijuana regulations, including those in Massachusetts, allow employers to prohibit use of the drug on the job or in the workplace even for those legally sanctioned to use it.

Beyond that, rules get murky. A handful of states, such as Arizona, Delaware, and Minnesota, prohibit employers from firing an employee for a positive marijuana drug test if the employee holds a valid state-issued card allowing the drug for medical use, said John DiNome, a Pennsylvania attorney who specializes in labor law at Reed Smith LLP, and who is not involved in Barbuto’s case.

Massachusetts law is silent on this issue.

Other states that have legalized medical marijuana, such as California and Oregon, allow employers to fire workers, even if they hold a valid marijuana card, DiNome said.

Further complicating the matter: Companies with federal contracts must follow federal drug laws that prohibit marijuana use, regardless of state law, DiNome said.

And then there are companies that hew to federal rules on marijuana regardless of state marijuana laws. “And the employee is sitting there saying, ‘Wait, state law says I can use legally,’ ” DiNome said.

Barbuto and her lawyers said they hope their case will add clarity — and protections — for Massachusetts patients.

“The whole marijuana law is so gray, someone has got to push it into a direction that will help everybody,” Barbuto said. “I hope this speaks to a lot of people who have gone through this or will go through this.”

Related:"Boston Police arrested a Somerville man at a Cambridge hospital late Sunday morning in connection with a home invasion just after midnight in an apartment on Endicott Street in the North End. Nikolas Angelesco, 19, and three other men allegedly broke into the apartment armed with knives and a sawed-off shotgun before taking off with several large bags of marijuana. A woman who was in the apartment with her boyfriend, who lived there, said the men appeared to be searching for something in a roommate’s room. The men left the apartment with several bags believed to contain marijuana. In the course of the incident, Angelesco accidently fired the gun. He drove himself to Cambridge hospital for with a gunshot wound in his foot. The woman and her boyfriend were not injured. Angelesco faces armed robbery, home invasion, and kidnapping charges."

"Drug abuse could be sleeper issue in 2016" by Jim O’Sullivan Globe Staff May 22, 2015PFFFFFFFFTTT!

Presidential campaigns have long been wary of the “October surprise,” the unforeseen, late-stage event or revelation that can alter the course of an election.OMG! What drugs are they on?!! Laughing in your face, they are!

Equally powerful can be sleeper issues that are sleepers because they don’t germinate in the high-level strategy powwows or in the much-maligned Washington think tanks, but among the masses, who collectively bum-rush them onto the agenda.I can't stand the elitism, I don't care what dope he's got.

Ronald Reagan surfed, all the way to the convention, on grass-roots concern that President Gerald Ford was poised to give away the Panama Canal. In 2008, the bases of both parties agreed that immigration policies were broken but disagreed about how to fix them; the fissures roiled the Republic primary and helped Barack Obama solidify his coalition.

In 2016, consider drug abuse as a potential heir to those from-the-bottom-up issues.

There is a drumbeat growing in both parties that could move the highly personal, painful matter of heroin and opioid drug addiction, which has metastasized into an epidemic, higher on the national agenda than at any time since the rampant crack crisis more than two decades ago.

Earlier this month in Manchester, Chris Christie, the Republican governor of New Jersey, said he would prioritize drug addiction as one of the “five or six” chief issues of his potential presidential bid.

On Monday in Mason City, Iowa, Hillary Rodham Clinton addressed drug abuse before she commented publicly on the Trans-Pacific trade deal, one of the central economic policy questions of the day. Calling it a “below the surface” issue, Clinton said she was “now convinced” that she needed to talk about it on the trail.

Not coincidentally, early-state politicians of both parties have already named it a defining problem. One Clinton campaign aide told the Globe that hearing about meth in Iowa and heroin in New Hampshire had prompted Clinton to ask her policy team to begin working on what she has previously called a “quiet epidemic.”

In Durham, N.H., last week, the Democratic former governor of Maryland, Martin O’Malley, said his state had seen more drug overdose fatalities than those from traffic deaths and homicides combined.

“What would we do if these individuals were suffering from Ebola?” O’Malley rhetorically asked reporters.

In Massachusetts, both Republican Governor Charlie Baker and Attorney General Maura Healey placed it front and center early in their terms, Healey calling it her “first major initiative.” Boston Mayor Martin J. Walsh, whose longtime activism in the recovery community helped win his election, made a legislative career of pushing for increased spending on recovery services.

“Talking about it, it makes them real in a lot of ways,” Walsh of the candidates. He likened addiction to gut-check concerns like housing prices and unemployment.

“This is one issue that crosses over party lines, crosses over economic lines. Whether it’s the top 2 percent of the country or the bottom 98 percent, addiction affects everybody the same way.”

Walsh said he spoke this week about drug abuse as a political issue with Boston-based Clinton adviser Michael Whouley, and added, “I think they’re all going to talk about it. I think the issue’s gone to a national level.”

Data would appear to back up the notion that there is a constituency of the concerned about opioids and heroin. A poll, conducted in April for the Globe and the Harvard T.H. Chan School of Public Health, revealed just how big it could be.

In both Massachusetts and the rest of the country, 39 percent said they knew someone who had abused prescription painkillers in the past five years. Fifty-one percent of those people in Massachusetts said they believed that usage had led to use of heroin or other illegal drugs; 43 percent nationwide.

In Massachusetts, 74 percent of people familiar with prescription abuse said it had wrought “major harmful” effects on the user’s family life; it was 67 percent across the country.

Those are the sort of big-bloc numbers that make the people who design a campaign’s message and policy points raise their heads and take notice.

And, as too many families can already attest, opioid abuse knifes through demographic strata. Through a cynically political lens, that means a candidate can talk on the issue with expected impact to voters who otherwise fall into tightly micro-targeted buckets.

Of course, primary-state pablum is one thing and actual policy enactment is quite another. Witness all the discussion in the last several presidential campaigns of the insolubility of Social Security, and the inaction that ensued. Or the lingering debate over immigration policy.

Landing squarely under the klieg lights of a presidential debate does not an unalloyed policy solution make. And none of the campaigns appears to have produced a sterling answer yet.

But, just as issues can steer elections, campaigns have a way of elevating issues. And, to those for whom the time to tackle drug abuse is not too late, it appears as if perhaps its time has come.

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